Bathroom related transit anxiety

September 3, 2014 6:04 AM

Lately, I have been starting to have symptoms of anxiety when I'm traveling in a vehicle that does not have a bathroom, or that can't easily be exited to find a bathroom. Of course, one of the symptoms of anxiety is needing to eliminate more urgently than normal, so this is becoming a feedback loop. I live in NYC and must use subways and taxis (over long bridges and through long tunnels) all the time. How can I cut the loop?

I try to practice calm deep breaths when I'm in the subway going under the East River or in a cab on the BQE when it's not moving. It helps, but doesn't get rid of the irrational anxiety. Several times recently I've had to exit a subway midway to my destination to find a bathroom, or had to ask a taxi to stop, and today when the B train stopped for five minutes underground on the incline up to the Manhattan bridge, I almost freaked out. (I was thisclose to announcing to the train car "I am having an anxiety attack. Can someone please talk to me to distract me and/or possibly hold my hand?") It's getting to the point that I'm starting to dread the subway. At this very moment I am delaying getting on the subway to return home to Brooklyn because I'm worried I'll be anxious again.

This is particularly perplexing to me because I've lived in cities and regularly used this kind of bathroom-less transit for my entire adult life. I don't have coping mechanisms (beyond the deep breathing) because I've never even thought about it before I started having this anxiety recently.

I'll be discussing this with my doctor at my next visit (which is in a few weeks). Until then, what can I do myself to help this anxiety abate?

posted by anonymous to Health & Fitness (13 answers total)

This used to be me! In my case, the no-bathroom anxiety is because I had some digestive issues and I was really worried Something Bad would happen if I couldn't get to a bathroom right away.

The key was to solve the digestive issues so I would no longer worry about the Something Bad. First, I cut out almost all dairy because I discovered I was lactose intolerant. I cut down a lot on caffeine. I don't eat anything remotely spicy. These three things have mostly solved the problem - some people will need more configuring. I would take antacids and anti-diarrheals as necessary and just plain plan ahead. If you're sure there will be nothing left by the time you're travelling, then there is nothing to worry about.

I'm also on medication for anxiety because I get panic attacks from other causes. Most likely your doctor will prescribe this for you, at least as a short-term course of action.

Right now: deep breathing helps. Also: counting backwards from 100. Counting objects (seats on the train, number of buildings you pass, number of people wearing gray jackets). Make up elaborate stories about the person sitting across from you. Press your fingernail into your palm or your thigh. Listen to absorbing audio books.

The people on the train are strangers who will forget you as soon as they get where they're going, so no matter what happens, even if it's Something Bad, it is not the end of the world. When you're at home or other safe space, think What Is the Worst That Could Happen, and think through how you would handle that.

I knew someone who was in a foreign country for the first time, standing on a train full of people, wearing WHITE PANTS with no change of clothes, and had Something Really Bad happen. He was really super embarrassed at the time, but he survived.
posted by desjardins at 6:31 AM on September 3, 2014

It's good you're going to see your MD. But perhaps, additionally, a therapist can help you uncover the root cause of this anxiety and coach you through some new coping mechanisms to calm yourself in these situations.

Until then, look around at all the other people and imagine they have to go even more urgently than you. Then tell yourself, I'll be fine. I know that person will **** in their pants long before me. I have nothing to worry about. Make it a game to find the best-dressed or otherwise most uptight person you can find - either across the subway car or in the next cab over. Think how hilarious it would be in a dumb teen comedy for that person to become a mess.

If you can find humor in the situation, your laughter (even internal laughter) will help relax you.
posted by trivia genius at 6:34 AM on September 3, 2014

Extending the thought of Avoiding Something Bad, I have observed my own habits and I know that I can definitely last more than an hour in between restroom visits. So before I get in a car during rush hour, I use the bathroom. That way I KNOW that I will be fine for at least the next hour, and I can relax about the delays in the journey.
posted by CathyG at 6:39 AM on September 3, 2014

You might know all this already, but one way of combatting anxiety like this is to not combat it at all: that is to say, allow yourself to experience the anxious thoughts/feelings/sensations as they come, but don't fight them. Focus on your breathing like you're doing already, and observe the thoughts and feelings that come, but don't try to push them away. Return your focus to your breathing whenever you can, but don't force it too much. If done right, the thoughts and feelings actually abate. It's as if they get their fuel from being pushed back against, as if the friction from pushing back keeps them hot. (I've heard people call anxious feelings "hot thoughts.")
posted by early one morning at 6:40 AM on September 3, 2014 [6 favorites]

I agree, fighting the thoughts is counterproductive. It is extremely unlikely that anything will actually happen, barring serious illness. (The white pants guy I mentioned above had food poisoning.)

Meditation teaches you not only how to breathe properly, but to let go of anxiety-producing thoughts. Three Pillars of Zen by Philip Kapleau is one of my very favorite books. It can get a little dense, but you have plenty of time to read on the train! Also suggested (for a bit lighter reading): anything by Pema Chodron. Meditation is completely compatible with atheism and also most religious belief systems, but if you already have a belief system, prayers from that tradition will likely serve the same purpose of reassurance.
posted by desjardins at 6:48 AM on September 3, 2014

I get transportation anxiety as well. To me, this appears like you are having an anxiety disorder which is manifesting itself as a need to have access to a bathroom. For me, I need to always carry with me water and a foodsource (like a powerbar) and my anxiety medication (lorazepam).

If I'm on a train and it just randomly stops - which they do all the goddamn time in Chicago - I instantly start to panic. "It's stopped. It's broken. We are trapped. We are 30 feet off the ground in between stops and we are trapped. I'm going to have to walk down the tracks to the nearest stop and try to not fall off. I'm going to be late for work." and shit like that, and it spirals really quickly until I'm almost having a full blown panic attack.... and then the train invariably starts moving again.

The food and water will allow me to survive in the eventual societal collapse of a stalled train (ha ha, no seriously). The lorazepam, however, that's the one. That's the important one. That's what really matters, because I know if I ever really do go over the edge into full blown panic attack, I can always get back with medication.

So what I'm suggesting is: go see your doctor immediately. Like, today. Anxiety disorders are odd; mine came out of nowhere as an adult, and the transportation related fears only started occurring in the past 2 years. Anxiety disorders can also be outrageously paralyzing. Mine is the fucking bane of my existence, but I understand it's quirks and I've learned to work around them.
posted by special agent conrad uno at 6:55 AM on September 3, 2014

In addition to the doctor's visit and the other good advice here, could you try distracting yourself? I used to have something similar, but mainly on planes during takeoff and landing when you're definitely not supposed to leave your seat. The new rules regarding electronic devices have been a godsend to be able to read or play some addictive phone game to get me through the taxi period which these days can be quite long. Does playing some stupid game or watching videos help take your mind at least partly away from your environment? I know it's important to be aware of your surroundings on public transport, so this might not be the best idea. But depending on the time of day of your commute, etc. it might help.
posted by bluefly at 7:06 AM on September 3, 2014

I want to add that the distracting myself has helped as a coping mechanism in addition to some therapy for anxiety. I don't mean to suggest it as the only answer.
posted by bluefly at 7:08 AM on September 3, 2014

I used to sometimes get these. It's pernicious as hell because being anxious can actually make you have to (or feel that you have to) go to the bathroom like RIGHT NOW even though, barring any sort of other medical issue, you probably don't.

I agree that I'd try to get to a doctor earlier if possible only because if you can't beat this back with mindfulness, the medication will in most cases, stop it totally dead. I've also had some luck retraining my brain to not feel that the first twinge of "Oh hey I've got to pee" is not the same as "Need to find a bathroom now"

Like, I know it's weird but I'll basically be like "OK how much water/liquid have you had? And you didn't have any more after X O'clock right? OK that is not actually an amount of water that will overfill your bladder so you are actually going to be okay if you can quit worrying about this. The next bathroom is in this location (there are great apps like Where2Wee)) and you haven't had anything to drink in an hour so this is not going to get worse." That sort of thing. Here's an older AskMe with some other advice for someone with a similar though not identical issue. Hope it's helpful.
posted by jessamyn at 8:29 AM on September 3, 2014 [1 favorite]

I get this, too (airplanes are stress-inducing because who knows how long it will be until they turn off the seatbelt light!).

It used to be much, much worse though: I used to urinate way more frequently, for example, I'd be getting up several times a night, and simple things like drive-throughs at restaurants where they block the cars in so you can't leave when the car in front of you takes a loooong time were stressful and panic-inducing. After reading an article on the subject, I started to train myself to just...hold it longer. After a few weeks of that, I could hold out for longer and no longer panicked when I had to go through the drive-through.

For gut problems, because anxiety goes straight to my guts and makes them rumble, first tracking my daily food intake made me realize that my guts are significantly calmer if I get at least 20 grams of fiber a day. For anxiety-inducing situations like airplane trips and long-distance car trips, Imodium, taken a couple of hours before the trip starts because I always have to pee a few times as it starts to take effect (I expect part of how it works is dehydration!).
posted by telophase at 8:56 AM on September 3, 2014

Take an over the counter anti-diarrhea pill before you leave the house, or carry them with you for a sense of comfort. Taking 1 or 2 daily shouldn't cause any issues in the short-term, and some IBS sufferers take them daily for months/years with no issues. It's a band-aid but it should stop you from actually having to go, so you'll feel the panic/anxiety but have a bit of comfort that nothing embarrassing will actually happen.

I had this issue, it flared up at a time when my stress levels were insane, so I was genuinely having stomach troubles, but the anxiety kicked it into hyperdrive and I started having panic attacks in meetings and anywhere else leaving was impossible or weird for me to come and go if I needed to go to the washroom. Do you have some other stress in your life right now? It could be expressing itself this way because you're not fully acknowledging it.

For me, when the stressful situation ended, my symptoms gradually got better. I still think about my fear but I no longer feel the panic. My stomach can rumble, I tense up a bit, but it no longer takes up a lot of space in my head and I can live my life.
posted by lafemma at 9:38 AM on September 3, 2014

I have major anxiety that manifests itself in several annoying ways, including urinary urgency. You don't mention if your need to eliminate is peeing or pooping. If it's peeing, you might look into training yourself to hold it longer. I got into this loop where I always needed to pee, so I would go all the time, which made my brain think "there is a little bit of urine in there, gotta get it out now!" so often to the point where I figured I might as well move my desk to the bathroom. I talked to my doctor and she said that you can do "urinary training" - there are whole regimens but basically force yourself to hold it a little longer each time. Your bladder stretches out and then you get better at holding more. Anyways by doing this you might be able to circumvent the transit anxiety as you'll be able to hold it longer.

Additionally you should look into relaxation techniques like mindfulness meditation to reduce your overall anxiety. A lot of MeFites have recommended Calm.com (and the smartphone app), and there is also a good app called The Mindfulness App.
posted by radioamy at 9:58 AM on September 3, 2014 [1 favorite]

How long is "lately"? Is there any chance you have a urinary tract infection? Some UTIs can be mild/asymptomatic enough that it doesn't occur to you that something is truly medically wrong (especially if you've never had one like that before). I could absolutely imagine it causing an anxiety loop, too. You might try an OTC drug like Uristat or Azo-Standard/Maximum Strength to see if it helps.
posted by unknowncommand at 6:06 PM on September 3, 2014